Method for crushing stones in urinary bladder and instrument for same

ABSTRACT

A method for crushing stones in the urinary bladder comprises successive multiple mechanical actions on the stone to be crushed by a working organ vibrating at ultrasonic frequency and hydraulic impacts formed by electrical discharge in the liquid medium which surrounds the stones. An instrument for effecting the method comprises elongated flexible ultrasonic and electrohydraulic lithotrites and respective ultrasonic drive means and electrical pulse means for exciting the lithotrites which have uniform systems of groundings and remote control.

United States Patent Inventors Jury Grigorievich Ediny Rovenskaya ulitsa7, kv. 58;

Oleg Gavrilovich Balaev, Prospect 40-1etia Oktyabrya, l00,kv. 174; BorisKirillovich Gostkin, ulitsa Erevanskaya, l4, kv. 35, Kiev, U.S.S.R.

Apr. 6, 1965 Jan. 26, 1971 Appl. No. Filed Patented METHOD FOR CRUSHINGSTONES 1N URINARY BLADDER AND INSTRUMENT FOR SAME 4 Claims, 2 DrawingFigs.

US. Cl 7. 128/328 Int. Cl v A6lb 17/00 Field of Search 128/328,

. [56] References Cited UNITED STATES PATENTS 2,227,727 l/l94l Leggiadro.1 128/328 2,764,683 9/1956 Paust et a]. 128/303.17 2,830,578 4/1958DeGroff 128/24.05 3,413,976 12/1968 Roze 128/328 PrimaryExaminer-Antonio F. Guida Assistant Examiner-Gregory E. McNeillAttorney-Waters, Roditi, Schwartz & Nissen ABSTRACT: A method forcrushing stones in the urinary bladder comprises successive multiplemechanical actions on the stone to be crushed by a working organvibrating at ultrasonic frequency and hydraulic impacts formed byelectrical discharge in the liquid medium which surrounds the stones. Aninstrument for effecting the method comprises elongated flexibleultrasonic and electrohydraulic lithotrites and respective ultrasonicdrive means and electrical pulse means for exciting the lithotriteswhich have uniform systems of groundings and remote control.

PATENTEU JANZS I97! SHEET 1- UF 2 PATENIED JAN26 my SHEET 2 OF 2 METHODFOR CRUSI-IING STONES IN URINARY BLADDER AND INSTRUMENT FOR SAME Thisinvention relates to methods and instruments for crushing concretions inthe urinary ducts, and more particularly, it relates to the methods andinstruments for crushing concretions in the urinary bladder.

Methods are known wherein stones in the urinary bladder are reduced insize by mechanical crushing for which purpose such mechanical means aslithotrites and cystolithotrites are used. The substantial drawback ofthese instruments is that they cannot break stones larger than mm. indiameter, are not sufficiently safe in use and besides they are notapplicable in constricted spaces of small urinary bladders.

Attempts have been made to use instruments for crushing concretions inthe urinary bladder which employ ultrasonic oscillations supplied to theworking organ introduced in the urinary bladder to contact theconcretion to be crushed.

However, these methods and instruments proved of little or no effect incrushing stones of varying structure and size and in case s cases whentheir number is great.

Therefore it is an object of the invention to develop a method foreffectively crushing stones of various structure and size, whatevertheir number in the urinary bladder may be.

Another object of this invention is to provide an operation and whichallows crushing of concretions in the urinary bladder by the saidmethod.

The principal object of the invention is to develop a method forcrushing concretions in the urinary bladder and to provide an instrumentfor realization of this method which would exert, on the stone to becrushed, remotely controlled actions varying in their character andintensity.

To achieve said principal object according to the invention, the methodfor crushing stones in the urinary bladder consists in that theconcrstion to be broken is acted upon alternately by mechanicaloscillations of ultrasonic frequency and a controlled hydraulic impactproduced by an electric discharge in the liquid medium surrounding theconcretion. An instrument for crushing concretion by said methodcomprises, according to the invention, elongated elastic lithotrites,which are introduced into the urinary bladder through the operatingcystoscope, one of which lithotrites is connected with the drive meansproducing mechanical oscillations at predominantly ultrasonic frequency,the other of said lithotrite being made in the form of coaxial insulatedelectrodes and coupled to a pulser means, said drive means and pulsermeans being operatively connected with a remote control device providedwith a selector switch bywhich the required kind of operation is set anda timer by which the time of operation of each of said means isrecorded.

The drive means preferably comprises a generator of ultrasonicoscillations, series connected with a remote control device through agrounding system which is connected with the cystoscope illuminatinglamp supply circuit, a converter of electric oscillations to mechanicalones, and with a concentrator of mechanical oscillations, saidconcentrator being connected with the lithotrite which is provided atits end with a working organ in the form of a hollow cylinder having aside bypass opening.

Said pulser means consists mainly of pulse-forming dischargers connectedwith the lithotrite electrodes and an accumulating device withcapacitors, supplied for instance from a power transformer, which isconnected with a remote control device through the grounding systemconnected with the cystoscope illuminating lamp supply circuit.

The invention will be described in greater detail hereafter with respectto the accompanying drawings in which:

FIG. 1 is a diagrammatic illustration of the instrument for crushingstones in the urinary bladder; and

FIG. 2 is an electric circuit diagram of the instrument shown in FIG. I.

For effective crushing of stones or concretions in the urinary bladderthey are first subjected to the mechanical effect of a member,oscillating predominantly with an ultrasonic frequency which results inthe formation of primary defects in the stone surfaces such as cavities,cracks, grooves and the like. Then an electric discharge is effected inthe liquid medium surrounding the stone, produce a controlled hydraulicimpact as a result of which the stone is split into fragments which aresubsequently crushed into minute removable fractions.

In the process of crushing very resistant stones ultrasonic oscillationsand electrohydraulic impacts can be arbitrarily alternated severaltimes.

The instrument for crushing stones in the urinary bladder (FIGS. 1 and2) comprises a generator 1 or ultrasonic oscillations employing tubes 2and 3, a magnetorestriction converter 4 of the electric oscillations toultrasonic mechanical oscillations and an exponential concentrator 5 ofsaid mechanical oscillations, said generator, converter and concentratorbeing connected in series.

The output of concentrator 5 is connected by means of a low-melting link6 with an elongated elastic lithotrite 7 carrying at its end a workingorgan 8 which comes into contact with the stone to be crushed.

The working organ 8 should preferably be made in the form of a hollowcylinder with a lateral bypass opening. The shank of the working organ 8and a portion of the lithotrite are enclosed in a hermetic protectivecatheter 9 tightly attached to the working organ 8.

The low-melting link 6 is enveloped with an with an electric heatingelement 10 supplied from a power source 11 and controlled from a timerelay 12 connected with a pilot lamp 13.

This allows interchange lithotrites. As soon as power is supplied to theheater 10, the low-melting link 6 melts and the time relay 12 cuts offpower supply.

The instrument has also another lithotrite 14 with two coaxialelectrodes 15 and 16 insulated from each other.

Lithotrite 14 is connected with the electric pulse generator 17comprising rectifier 18 assembled in accordance with a doubling circuitemploying semiconductor elements 19, 20 and supplied form a powertransformer 21.

To the rectifier 18 is connected an accummulating device with capacitors22 and 23 whose charge is transmitted to the pulse-forming dischargers24 made, for example, as two tungsten cylinders having plane-paralleldischarge surfaces.

Electric pulses from dischargers 24 pass to electrodes 15, 16 betweenthe insulated ends of which an electric arc is formed as a result ofwhich a shock wave is produced in the liquid medium surrounding thestone. To obtain a shock wave of a required form and direction, themutual position of the ends of electrodes 15 and 16 can be arrangedeither in the same plane or in different planes.

Said lithotrites 7 and 14 are introduced into the urinary bladderthrough an operative cystoscope 25 having an illuminating lamp 26.

Generator 1 of ultrasonic oscillations and electric pulse generator 17are associated with a general remote control device 27 through agrounding system connected with illuminating lamp 26 of cystoscope 25.

The grounding system has a grounding busbar 28 to which a semiannularclamp 29 is attached by means of two pins, viz. a stationary pin 30insulated from the clamp 29 and a pin 31 connected with the clamp 29 bymeans of the thread. One of wires supplying power to the lamp 26 issoshorted through the grounding busbar 28 that the lamp 26 goes out whenthere is no contact in the grounding circuit. This will provide for thesafety of operating with the instrument.

A remote control device 27 comprises a foot pedal 32, time recordingunit or timer 33, actuated by an electromechanical relay 34 and aselector switch 35 which sets the required mode of operation.

After the instrument is switched on by means of the foot pedal 32, a redpilot lamp 36 is lighted and the electromechanical relay 34 operatesswitch on the time recording unit (electric stopwatch) 33.Simultaneously, depending on the position of the selector switch 35,either the generator 1 of ultrasonic oscillations or the pulser 17starts working together with either lithotrite] or 14 respectively.

The process of stone crushing is controlled visually through cystoscope25. Stone structure and size determine the choice of action.

By alternating ultrasonic and hydraulic actions on the stone and bychanging the duration of such actions, stones in the uri nary bladdercan be effectively crushed.

lclaim:

l. A method for crushing stones in the urinary bladder, comprisingalternately applying mechanical action to a stone to be crushed by aworking element vibrating at ultrasonic frequency and applying hydraulicimpact by producing electrical discharges in a liquid medium surroundingthe stone to be crushed.

2. An instrument for crushing stones in the urinary bladder incombination with an operative cystoscope having an illuminating lampwith power supply and comprising elongated lithotrites adapted for beingintroduced into the urinary bladder through said cystoscope to contactthe stone to be crushed; one of said lithotrites being capable oftransmitting ultrasonic oscillations for crushing the stone; the otherlithotrite having coaxial electrodes and separating insulating material,drive means for generation and conversion of electrical oscillationsinto mechanical ultrasonic oscillations and their transmission to thefirst lithotrite; an electrical pulser means connected to said otherlithotrite for producing electrical discharges between end faces of saidcoaxial electrodes in the liquid medium of the urinary bladder to causethe formation of hydraulic impacts crushing the stones; remote controlmeans for said drive and electric pulser means, said remote controlmeans including a selector switch, an operating time register for eachof said drive means and said electric pulser means and means for turningthe registers on and off successively and a grounding circuit connectedto the power supply circuits of said cystoscope lamp and to said meansfor turning the registers on and off.

3. An instrument for crushing stones in the urinary bladder incombination with an operative cystoscope having an illuminating lampwith power supply and comprising two elongated lithotrites adapted forbeing introduced alternatively into the urinary bladder through saidcystoscope to contact the stone to be crushed; the first lithotriteincluding at one end thereof a working element in the form of a hollowcylinder with a bypass opening, and a protective waterproof sheath onsaid cylinder capable of transmitting an ultrasonic vibration whichcrushes the stone, the second lithotrite including coaxial electrodesinsulated the entire length up to the end face sur faces thereof by aninsulation material with substantial electrical and impact strength; adrive means for imparting to the first lithotrite mechanical strengthultrasonic oscillations, said drive means comprising a generator ofelectric oscillations, a

converter of electric oscillations into ultrasonic mechanicaloscillations connected in series with said generator, a concentrator ofmechanical oscillations connected to said converter and to the firstlithotrite; an electric pulser means connected to the second lithotritefor producing electrical discharges between the end faces of saidcoaxial electrodes in the liquid medium of the urinary bladder to causethe formation of hydraulic impacts for crushing of the stone; remotecontrol means for said drive means and said electrical pulser means,said remote control means including a selector switch, an operating timeregister for each of said drive means and said electrical pulser andmeans for turning said registers on and off successively, and agrounding circuit connected to the power supply circuits of saidcystoscope lamp and to said means for turning said registers on and off.

4. An instrument for crushing stones in the urinary bladder incombination with an operative cystoscope having an illuminating lampwith power supply, and comprising two elongated lithotrites adapted forbeing introduced alternatively into the urinary bladder through saidcystoscope to contact the stone to be crushed; the first lithotriteincluding at an end thereof a working element in the form of a cylinderwith a bypass opening, and a protective waterproof sheath capable oftransmitting ultrasonic vibratory impacts for crushin the stone, thesecond lithotrite having coaxial electrodes msu ated the entire lengththereof up to the end face surfaces by insulation material with highelectric and impact strength; a drive means for imparting mechanicalultrasonic oscillations to the first lithotrite, said drive meanscomprising a generator of electrical oscillations, a converter ofelectrical oscillations into mechanical ultrasonic oscillationsconnected in series with said generator, a concentrator of mechanicaloscillations connected to the first lithotrite by means of a fusiblewelding alloy; an electrical electrical pulser means comprising aseriesconnected rectifier, an accumulating means with capacitors and atleast two pulse shaping dischargers connected to said electrodes of thesecond lithotrite for producing between their end faces electricdischarges in the liquid medium of the urinary bladder to cause theformation of hydraulic impacts for crushing the stone; remote controlmeans for said drive means and said electrical pulser means, said remotecontrol means including a selector switch, an operating time register ofeach of said drive means and said electrical pulser means and means forturning said registers on and off successively; and a grounding circuitconnected to the power supply circuits of said cystoscope lamp and tosaid means for turning said registers on and off, said grounding circuitincluding a hand screw having two stems insulated from each other andaffixed on a grounded collecting bar

1. A method for crushing stones in the urinary bladder, comprisingalternately applying mechanical action to a stone to be crushed by aworking element vibrating at ultrasonic frequency and applying hydraulicimpact by producing electrical discharges in a liquid medium surroundingthe stone to be crushed.
 2. An instrument for crushing stones in theurinary bladder in combination with an operative cystoscope having anilluminating lamp with power supply and comprising elongated lithotritesadapted for being introduced into the urinary bladder through saidcystoscope to contact the stone to be crushed; one of said lithotritesbeing capable of transmitting ultrasonic oscillations for crushing thestone; the other lithotrite having coaxial electrodes and separatinginsulating material, drive means for generation and conversion ofelectrical oscillations into mechanical ultrasonic oscillations andtheir transmission to the first lithotrite; an electrical pulser meansconnected to said other lithotrite for producing electrical dischargesbetween end faces of said coaxial electrodes in the liquid medium of theurinary bladder to cause the formation of hydraulic impacts crushing thestones; remote control means for said drive and electric pulser means,said remote control means including a selector switch, an operating timeregister for each of said drive means and said electric pulser means andmeans for turning the registers on and off successively and a groundingcircuit connected to the power supply circuits of said cystoscope lampand to said means for turning the registers on and off.
 3. An instrumentfor crushing stones in the urinary bladder in combination with anoperative cystoscope having an illuminating lamp with power supply andcomprising two elongated lithotrites adapted for being introducedalternatively into the urinary bladder through said cystoscope tocontact the stone to be crushed; the first lithotrite including at oneend thereof a working element in the form of a hollow cylinder with abypass opening, and a protective waterproof sheath on said cylindercapable of transmitting an ultrasonic vibration which crushes the stone,the second lithotrite includinG coaxial electrodes insulated the entirelength up to the end face surfaces thereof by an insulation materialwith substantial electrical and impact strength; a drive means forimparting to the first lithotrite mechanical strength ultrasonicoscillations, said drive means comprising a generator of electricoscillations, a converter of electric oscillations into ultrasonicmechanical oscillations connected in series with said generator, aconcentrator of mechanical oscillations connected to said converter andto the first lithotrite; an electric pulser means connected to thesecond lithotrite for producing electrical discharges between the endfaces of said coaxial electrodes in the liquid medium of the urinarybladder to cause the formation of hydraulic impacts for crushing of thestone; remote control means for said drive means and said electricalpulser means, said remote control means including a selector switch, anoperating time register for each of said drive means and said electricalpulser and means for turning said registers on and off successively, anda grounding circuit connected to the power supply circuits of saidcystoscope lamp and to said means for turning said registers on and off.4. An instrument for crushing stones in the urinary bladder incombination with an operative cystoscope having an illuminating lampwith power supply, and comprising two elongated lithotrites adapted forbeing introduced alternatively into the urinary bladder through saidcystoscope to contact the stone to be crushed; the first lithotriteincluding at an end thereof a working element in the form of a cylinderwith a bypass opening, and a protective waterproof sheath capable oftransmitting ultrasonic vibratory impacts for crushing the stone, thesecond lithotrite having coaxial electrodes insulated the entire lengththereof up to the end face surfaces by insulation material with highelectric and impact strength; a drive means for imparting mechanicalultrasonic oscillations to the first lithotrite, said drive meanscomprising a generator of electrical oscillations, a converter ofelectrical oscillations into mechanical ultrasonic oscillationsconnected in series with said generator, a concentrator of mechanicaloscillations connected to the first lithotrite by means of a fusiblewelding alloy; an electrical electrical pulser means comprising aseries-connected rectifier, an accumulating means with capacitors and atleast two pulse shaping dischargers connected to said electrodes of thesecond lithotrite for producing between their end faces electricdischarges in the liquid medium of the urinary bladder to cause theformation of hydraulic impacts for crushing the stone; remote controlmeans for said drive means and said electrical pulser means, said remotecontrol means including a selector switch, an operating time register ofeach of said drive means and said electrical pulser means and means forturning said registers on and off successively; and a grounding circuitconnected to the power supply circuits of said cystoscope lamp and tosaid means for turning said registers on and off, said grounding circuitincluding a hand screw having two stems insulated from each other andaffixed on a grounded collecting bar.